Lessons learned: providing culturally competent care in a nurse-managed center

ABNF Journal, The, July-August, 2004 by Valerie Browne-Krimsley

Abstract: The author discusses the conceptualization and implementation of a university and community sponsored nursing care center to meet the needs of the community. A case study is given illustrating the cogent points dealt with in the article.

Key Words: Nurse-Managed Center, Culturally Competent Nursing Care

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The University of Central Florida (UCF) is located in Orlando, Florida and has branch campuses in Volusia and Brevard counties. The mission of the university is to provide excellent accessible education that serves the needs of area residents. In fulfilling this mission, the University believes it should participate in and contribute to the community.

On each of the campuses, the university offers a baccalaureate degree program in nursing. As part of the program, students have a public/community health course. Public Health Nursing has a long history of advocating for needs of poor, disenfranchised people. The UCF Nursing Department has a strong commitment to providing community health education experiences for their students that are responsive to rapid changes and inadequacies of the existing health care system. The UCF's Community Nursing Center, a nurse-managed center, was created to meet the needs of the community it serves, and has been in operation since April, 1992.

The mission of the University of Central Florida's Community Nursing Center, Project Liftoff, is to involve student nurses in the educational process of fostering individual and community participation in solving health problems and issues affecting clients they serve. The conceptual framework for Project Liftoff is one of individual and community empowerment; processes involve information, skills, and resources to improve decision-making power of individuals and groups served by the project.

ORGANIZATION PARTNERS

The UCF Community Nursing Center has partners that have contributed greatly to the project and its existence. Current partners include Brevard County Public Health Unity, Brevard County Housing Authority (Housing and Urban Development [HUD]), United Way, Brevard County Family Services, Prenatal and Infant Health Care Coalition of Brevard County, Inc., Community Commons (a coalition of banks, businesses, social service organizations and Brevard Community College), and UCF. Brevard County Housing Authority contributes a three-room unit with water, gas, and parking in the housing project for the Community Nursing Center. The United Way donates funds for two phone lines. Brevard County Family Services assumes expenses of the electric bill; and the Brevard County Public Health Department provides consultative and referral services for clients with complex health matters, especially as they relate to issues of pregnancy, reproduction, and child health. The Health Department supports the Community Nursing Center with supplies. They also support and endorse the notion of nursing students providing primary care directly in client's homes.

At the UCF Community Nursing Center, nursing students are the pivotal providers who see community residents for planned care. Project Liftoff operates twelve months a year. Services provided by students are under the supervision of experienced faculty and through faculty practice. This faculty has a variety of experiences working in minority communities, often spearheading innovative culturally appropriate models of health care delivery. The faculty has a multicultural background, and all of its members have served on cultural diversity committees. Specialty experiences and education of nursing faculty are in women's health, pediatric health, community health, and community organization.

CLIENT POPULATION SERVED

The population being served by Project Liftoff is the most heavily concentrated area of low income African Americans in Cocoa and Brevard Counties. There are 710 apartments, housing approximately 4,250 residents. Of those, 3,272 are African American. Sixty-three percent of the residents served by Project Liftoff have incomes below the poverty level, with an average household income of $10,940 per annum. Fifty-three percent of the population is of childbearing age (U.S. Census Data, 2000).

Infant mortality, an indirect measure of the health of the mother and infant, and the effectiveness of the health care system is 15/1000 for non-white infants compared to 7/1000 for white infants in Brevard County. Prenatal care begun in the first trimester of pregnancy, an important predictor of healthy babies, was at 77% in Brevard County as a whole, but at only 50% for the high-risk populations (Improved Pregnancy Outcome Data, 1993). Teen pregnancy was at 50.9/1000, ages 15-19 in 1991. For non-white teens, this figure is 116.3/1000. It is estimated that half of these mothers will become mothers for the second time within two years (Healthy Beginnings: University of South Florida, 1999). The project has positively impacted the number of low birth weight infants born in this zip code, decreasing the rate from 11.4 to 7.6 over the last six years (Prenatal & Infant Health Care Coalition of Brevard, 2001).